Aid Cuts Could Reverse Global Health Gains, Study Warns

A sustained reduction in official development assistance could result in nearly 23 million additional deaths by 2030 across 93 low- and middle-income countries, according to a new peer-reviewed study published in The Lancet Global Health. The findings suggest that recent and projected cuts by major donor countries risk undoing decades of progress in reducing preventable mortality, with children and fragile health systems facing the highest exposure.

“These analyses show that development assistance is among the most effective global health interventions available,” says Davide Rasella, Coordinator of the Study and a Research Professor, Barcelona Institute for Global Health (ISGlobal). He says that withdrawing this support would translate directly into millions of avoidable adult and child deaths, adding that budget decisions taken by donor governments will have irreversible consequences over the coming years.

The study was led by ISGlobal with support from the Rockefeller Foundation and its public charity, RF Catalytic Capital. It evaluates the impact of official development assistance (ODA) on mortality trends between 2002 and 2021 and projects outcomes through 2030 under different funding scenarios. ODA represents the largest and most consistently measured source of humanitarian and development financing for low- and middle-income countries, supporting health care, education, food security, water and sanitation, and disease control.

The analysis comes as international aid enters a period of contraction. In 2024, global aid declined for the first time in six years. The United States, the United Kingdom, France, and Germany all reduced ODA contributions in the same year, marking the first such simultaneous reduction by these donors in nearly three decades. According to the Organisation for Economic Co-operation and Development (OECD), ODA could fall between 10% and 18% from 2024 to 2025, with further cuts projected into 2026.

Using longitudinal panel data from 93 countries, the researchers applied a two-way fixed-effects regression model adjusted for demographic, socioeconomic, and health system factors. They then integrated those findings into country-level microsimulation models to estimate future mortality under mild and severe defunding scenarios. The countries included in the study account for about 6.3 billion people, or about three-quarters of the global population, spanning sub-Saharan Africa, Asia, Latin America, the Middle East and North Africa, and parts of the European Union.

The retrospective analysis found that higher ODA levels were associated with a 23% reduction in all-cause mortality and a 39% reduction in deaths among children under five. The strongest effects were observed in communicable diseases, including a 70% reduction in HIV/AIDS mortality and declines of more than 50% in deaths linked to malaria, nutritional deficiencies, diarrheal diseases, and neglected tropical diseases. The study also links aid flows to stronger health systems and improved preparedness for outbreaks and epidemics.

Looking ahead, the study outlines two primary risk scenarios. Under a mild defunding scenario, defined as a continuation of recent downward trends in aid, the researchers estimate 9.4 million additional deaths by 2030, including 2.5 million children under five. Under a severe defunding scenario, based on deeper and sustained cuts, projected excess mortality rises to 22.6 million deaths across all ages, including 5.4 million young children. The authors note that this toll would be comparable to the combined populations of several major global cities or the loss of an entire mid-sized country within a decade.

Sub-Saharan Africa faces the highest exposure, with 38 of the 93 countries analyzed located in the region. Asia accounts for 21 countries, Latin America for 12, the Middle East and North Africa for 12, and the European Union for 10, including Ukraine. The researchers warn that at least three out of every four people globally live in countries where two decades of development gains could be reversed if current funding trajectories persist.

Rajiv Shah, President, Rockefeller Foundation, describes the findings as a warning about the moral and human costs of current policy choices. In a statement, he says the question facing governments is whether to accept a retreat from long-standing commitments to reduce hunger and disease or to develop new models of cooperation capable of sustaining progress.

Evidence of disruption linked to aid retrenchment is already emerging. In 2025, food reserves valued at over US$98 million were reported stranded in warehouses in Djibouti, South Africa, Dubai, and Houston following funding freezes and contract cancellations tied to cuts at the US Agency for International Development. According to data cited, the supplies could have fed millions of people for weeks or months but instead risked spoilage or destruction due to delays in authorization and transport. Manufacturers of therapeutic foods have reported backlogs that force additional storage costs while malnutrition risks rise in recipient countries.

Education, another sector heavily dependent on development assistance, is also under strain. Education Cannot Wait, the United Nations fund for education in emergencies, reported reaching 8.3 million children and adolescents affected by crises in 2024. Despite gains in enrollment and retention, the organization says only about 30% of education funding needs in humanitarian appeals were met that year, underscoring the limits of financing. UN officials have warned that millions of children risk losing access to schooling as aid gaps widen.

Health research and disease prevention programs face similar pressures. Long-term investments have supported advances such as large-scale HIV prevention trials and expanded access to treatment and prophylaxis in middle-income countries, including Mexico. Global strategies aligned with the UN Sustainable Development Goals rely on consistent funding to sustain progress against HIV/AIDS, tuberculosis, and malaria. The ISGlobal study cautions that interruptions in aid threaten not only service delivery but also the research pipelines and public health infrastructure needed to control future outbreaks.

At the same time, some regional and multilateral actors are seeking to offset global aid contractions. The Development Bank of Latin America and the Caribbean (CAF) launched a US$5 billion initiative aimed at benefiting 50 million children and youth in the region over five years. Announced at the UN General Assembly in partnership with UNICEF, the program applies a child-focused investment framework to projects in health, education, and protection. CAF officials say the initiative reflects growing efforts by Global South institutions to mobilize alternative financing as traditional aid flows decline.

While such initiatives provide partial relief, analysts involved in the ISGlobal study stress that they cannot fully replace the scale or scope of official development assistance. Philanthropic organizations and development banks may catalyze investment and innovation, but ODA remains the backbone of financing for health systems and humanitarian response in many countries.

The study builds on earlier research that estimated the dismantling of USAID alone could lead to more than 14 million additional deaths by 2030. By expanding the analysis to include all OECD donors, the new findings offer a broader view of how coordinated or overlapping cuts could compound risks across regions and sectors.

The authors conclude that reversing defunding trends is critical to maintaining progress toward the Sustainable Development Goals and preventing a sharp rise in preventable mortality. They argue that aid decisions should be evaluated not only in fiscal terms but also through their long-term human and economic consequences. Systems built over decades can erode quickly, and restoring them once dismantled may prove far more costly than sustaining them, says Rasella.